The Affordable Care Act Survives After the Supreme Court abandons the latest challenges

(WASHINGTON) – The Supreme Court on Thursday ruled out a major challenge to the Obama-era health care law, overturning a Republican-led state effort to overturn the law that provides insurance coverage for millions of Americans.

The judges, with a 7-2 vote, left the entire law intact saying that Texas, other GOP-led states and two individuals did not have the right to take their case to federal court. The Biden administration says 31 million people have health insurance because of the law popularly known as “Obamacare”.

Key provisions of the law include protections for people with pre-existing health conditions, a range of free preventive services and the expansion of the Medicaid program that insures people on lower incomes, including those working in jobs that they don’t pay much or provide health insurance.
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It also leaves in place the toothless oral requirement of the law that people have health insurance or pay a penalty. Congress made such a provision irrelevant in 2017 when it reduced the penalty to zero.

The elimination of the penalty had become the hook that Texas and other states led by the Republic, as well as the Trump administration, used to attack the entire law. They argued that without the mandate, a pillar of the law when it was passed in 2010, the rest of the law would have to fall as well.

And with a more conservative Supreme Court that includes three nominees by Trump, Obamacare’s opponents have hoped that a majority of judges will finally kill the law against which they have been fighting for more than a decade.

But the third major attack on the law in the Supreme Court ended the way the first two did, with a majority of the court rejecting efforts to violate the law or get rid of it all.

The three Trump nominees to the Supreme Court – Judges Amy Coney Barrett, Neil Gorsuch and Brett Kavanaugh – have split their votes. Kavanaugh and Barrett have joined the majority. Gorsuch disagreed, signing an opinion from Judge Samuel Alito.

Judge Stephen Breyer wrote to the court that states and individuals who have filed a federal lawsuit “have not shown that they have been attacked as unconstitutional by the Act’s minimum essential coverage provision.”

Disagreeing, Alito wrote: “Today’s decision is the third part of our epic Affordable Care Act trilogy, and it follows the same pattern as rates one and two. In all three episodes, with the Affordable Care Act facing a serious threat, the Court made an unlikely rescue. ”Alito was also a dissident in the two previous cases.

Because it rejected the case for lack of legal status of the plaintiff – the ability to sue, the court did not really rule on whether the individual warrant was unconstitutional now that there is no penalty for waiving insurance. The lower courts had overturned the warrant, in decisions which were overturned by the decision of the Supreme Court.

With the latest decision, the ACA is “here to stay for the foreseeable future,” said Larry Levitt, executive vice president of the nonprofit Kaiser Family Foundation, which studies health care.

“Democrats are in office and have made revitalization and building on the ACA a key priority,” Levitt said. “Republicans don’t seem to have much enthusiasm for continuing to try to repeal the law.”

Republicans have pressed their argument to invalidate the entire law even if Congress’s efforts to tear down the entire “root and branch” law, in the words of GOP Senate Leader Mitch McConnell, have failed. The closest they came was in July 2017 when Arizona Sen. John McCain, who died the following year, made a dramatic vote in an effort to repeal it from his fellow Republicans.

Chief Justice John Roberts said during the November arguments that enemies of the law asked the court to do the job better left to the political branches of government.

The court’s decision retains benefits that have become part of the fabric of the nation’s health system.

Surveys show that the 2010 health care law has grown in popularity since it withstood the heaviest assault. In December 2016, just before Obama left office and Trump swept the ACA into calling it a “disaster,” 46% of Americans had an unfavorable view of the law, while 43% approved it, according to the survey. follow-up to the Kaiser Family Foundation. These assessments were dropped and by February of this year 54% had a favorable view, while disapproval had fallen to 39% in the same current survey.

The health care law is now undergoing an expansion under President Joe Biden, who sees it as the foundation for moving the United States to coverage for all. Its giant relief plan COVID-19 has significantly increased subsidies for private health plans offered through the ACA’s insurance markets, despite pending higher federal payments ahead of the dozen states that have refused the Medicaid expansion of the law. About 1 million people have signed up for since Biden reopened enrollment amid high levels of COVID cases earlier this year.

Most people with insurance under the law have it through the expanding Medicaid or health insurance markets that offer subsidized private plans. But its most popular benefit is protection for people with pre-existing medical conditions. They cannot be denied coverage because of health problems, or charge a higher premium. While those covered by the employer’s plans already had such protections, “Obamacare” guaranteed them for people who buy individual policies.

Another very popular benefit has allowed young adults to stay on their parents ’health insurance until they turn 26 years old. Before the law, going without medical coverage was similar to a rite of passage for 20-year-olds who had a start in the world.

Because of the ACA, most privately insured women receive birth control for free. It is considered a covered preventive benefit at no additional cost to the patient. So are routine screenings for cancer and other conditions.

For Medicare recipients, “Obamacare” also improved preventive care, and more importantly, closed a multi-thousand dollar prescription drug coverage gap that was known as the “donut hole”.


Associated Press Secretary Ricardo Alonso-Zaldivar contributed to this report.

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